Survival benefit of conversion surgery after intensive chemotherapy for unresectable metastatic gastric cancer: a propensity score-matching analysis

Ohnuma, Hiroyuki; Sato, Yasushi; Onoyama, Naoki; Hamaguchi, Kota; Hayasaka, Naotaka; Sato, Masanori; Murase, Kazuyuki; Takada, Kohichi; Miyanishi, Koji; Murakami, Takeshi; Itô, Tatsuya; Nobuoka, Takayuki; Takemasa, Ichiro; Kato, Junji

doi:10.1007/s00432-021-03516-7

Cited by 5 publications

(5 citation statements)

References 44 publications

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“…The reported incidence of CS varies from 17.7% to 34.9% in large-scale retrospective studies [8][9][10][11]. This is slightly higher than our findings, potentially because patients with technically resectable metastases (Yoshida classification category 1) were excluded from our study.…”

Section: Discussioncontrasting

confidence: 68%

“…This renders the primary lesion ± the remains of the metastases resectable [2]. This surgery has recently been referred to as conversion surgery (CS), and several retrospective studies have shown its favorable outcomes [3][4][5][6][7][8][9][10][11]. Nevertheless, the clinical significance of CS remains unclear, owing to the lack of prospective clinical trials.…”

Section: Introductionmentioning

confidence: 99%

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Low Expectancy of Conversion Surgery with R0 Resection in Patients with CEA > 5.0 ng/mL at the Initial RECIST Evaluation for Metastatic Gastric Cancer

Nakanishi,

Tanaka,

Kanda

et al. 2023

Cancers

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This retrospective study examined early the predictive factors for successful conversion surgery (CS) with R0 resection in patients with metastatic gastric cancer (MGC) who underwent systemic chemotherapy. This study included 204 patients diagnosed with metastatic gastric adenocarcinoma, who received chemotherapy between 2009 and 2019. Of these patients, 31 (15%) underwent CS with R0 resection. The incidence of CS with R0 resection was not affected by the volume of metastatic lesions or the presence of peritoneal metastasis. The overall survival time of the CS with R0 resection group was significantly longer than that of the non-CS group (hazard ratio, 0.12; 95% confidence interval, 0.07–0.23; p < 0.0001), with a 5 year overall survival rate of 50.2%. Multivariate analysis of 150 patients, excluding those with disease progression until the initial Response Evaluation Criteria in Solid Tumors (RECIST) evaluation, showed that carcinoembryonic antigen > 5.0 ng/mL at the initial RECIST evaluation was an independent, significant, and unfavorable predictor of CS with R0 resection (odds ratio, 0.21; p = 0.0108), whereas systemic chemotherapy with trastuzumab for HER2-positive cancer was a favorable factor (odds ratio, 4.20; p = 0.0119). Monitoring serum carcinoembryonic antigen levels during chemotherapy may be a useful predictor of the CS implementation in patients with MGC.

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Section: Discussioncontrasting

confidence: 68%

Section: Introductionmentioning

confidence: 99%

Low Expectancy of Conversion Surgery with R0 Resection in Patients with CEA > 5.0 ng/mL at the Initial RECIST Evaluation for Metastatic Gastric Cancer

Nakanishi,

Tanaka,

Kanda

et al. 2023

Cancers

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“…There are many criticisms that the study did not employ an appropriate dosage regimen and ultimately did not achieve satisfactory results. Several studies have reported the usefulness of triple-drug combination therapy in cases where conversion therapy is intended [ 46 , 47 ].…”

Section: First-line Her2-negative Gastric Cancermentioning

confidence: 99%

Overview of Chemotherapy for Gastric Cancer

Sato

Okamoto

Kida

et al. 2023

JCM

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Gastric cancer (GC) is one of the most clinically challenging cancers worldwide. Over the past few years, new molecular-targeted agents and immunotherapy have markedly improved GC prognosis. Human epidermal growth factor receptor 2 (HER2) expression is a key biomarker in first-line chemotherapy for unresectable advanced GC. Further, the addition of trastuzumab to cytotoxic chemotherapy has extended the overall survival of patients with HER2-positive advanced GC. In HER2-negative GC, the combination of nivolumab, an immune checkpoint inhibitor, and a cytotoxic agent has been demonstrated to prolong the overall survival of GC patients. Ramucirumab and trifluridine/tipiracil, which are second- and third-line treatments for GC, and trastuzumab deruxtecan, an antibody–drug conjugate for HER2-positive GC, have been introduced in clinics. New promising molecular-targeted agents are also being developed, and combination therapy comprising immunotherapy and molecular-targeted agents is expected. As the number of available drugs increases, it is important to understand the target biomarkers and drug characteristics and select the optimal therapy for each patient. For resectable disease, differences in the extent of standard lymphadenectomy between Eastern and Western countries have led to different standard treatments: perioperative (neoadjuvant) and adjuvant therapy. This review aimed to summarize recent advances in chemotherapy for advanced GC.

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“…Given the importance of the proper selection of candidates for conversion surgery aimed at curative R0 resection, recent studies on conversion surgery focused on factors associated with survival [14,15,17,[19][20][21][22][23][24][25]. Multivariable analyses identified several prognostic factors that can be divided by their timing of clinical acquisition [19,20,[22][23][24]. Firstly, Eastern Cooperative Oncology Group (ECOG) performance status, ascites, and the number of incurable factors were identified before the initiation of chemotherapy.…”

Section: Introductionmentioning

confidence: 99%

The Clinical Implication of Conversion Surgery in Patients with Stage IV Gastric Cancer Who Received Systemic Chemotherapy

Shin,

Choi,

Kim

et al. 2023

Biomedicines

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With the advances in chemotherapy and immunotherapy, a small subset of patients may be eligible for conversion surgery after achieving tumor regression with chemotherapy. This is a retrospective cohort study of 118 patients with stage IV gastric cancer who received palliative chemotherapy and conversion surgery with a negative resection margin at Samsung Medical Center. Baseline features included comorbidities, body mass index (BMI), carcinoembryonic antigen (CEA) level, primary tumor size, biopsy histology, distant metastatic sites, and molecular markers—HER2, MSI/MMR, PD-L1, and EBV. Post-chemotherapy features included BMI, CEA level, chemotherapy regimen, objective response to chemotherapy, and number of preoperative chemotherapy cycles. Post-operational features included tumor size, histologic differentiation and Lauren’s classification, pathologic tumor and nodal stages, invasion of lymphatics/vessels/nerves, peritoneal cytology, and the receipt of postoperative chemotherapy. Of 118 patients, 60 patients received total gastrectomy and 58 patients received subtotal gastrectomy. In all, 21 patients achieved a pathologic complete response, and 97 patients achieved downstaging to yp stage I, II, or III. Before conversion surgery, patients received first-line capecitabine/oxaliplatin (62%), HER2 inhibitors combined with chemotherapy (18%), immune checkpoint inhibitors (15%), and inhibitors of MET or VEGFR2 (5%). In the multivariable analysis, BMI at the time of diagnosis, either HER2 positive, high MSI, or deficient MMR, and the use of targeted agents were significant prognostic factors. Conversion surgery could be considered in patients with stage IV gastric cancer regardless of the initial disease burden. BMI and molecular markers are important prognostic factors that can be used to select candidates.

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Survival benefit of conversion surgery after intensive chemotherapy for unresectable metastatic gastric cancer: a propensity score-matching analysis

Cited by 5 publications

References 44 publications

Low Expectancy of Conversion Surgery with R0 Resection in Patients with CEA > 5.0 ng/mL at the Initial RECIST Evaluation for Metastatic Gastric Cancer

Low Expectancy of Conversion Surgery with R0 Resection in Patients with CEA > 5.0 ng/mL at the Initial RECIST Evaluation for Metastatic Gastric Cancer

Overview of Chemotherapy for Gastric Cancer

The Clinical Implication of Conversion Surgery in Patients with Stage IV Gastric Cancer Who Received Systemic Chemotherapy

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